East Coast Plastic Surgery would like to ask for your permission to share the attached corresponding photographs for educational purposes. These types of photographs are very helpful when assisting other patients to make informed decisions about their surgery.
Names are not used, and identifying features can be masked upon request.
I understand that the attached photographs may be published for educational purposes:
- To educate patients on the East Coast Plastic Surgery website and/or the CosMediTour website.
- To educate patients within the East Coast Plastic Surgery clinic and/or CosMediTour office.
- To educate patients through East Coast Plastic Surgery social media accounts and/or CosMediTour social media accounts.
I understand that any image of myself used in advertising, particularly on social media platforms, may be viewed, shared, reproduced, or commented on by third parties without the knowledge or control of East Coast Plastic Surgery or myself.
All patient photographs are stored within a password protected practice management software solution that can only be accessed by surgeons and staff of East Coast Plastic Surgery. This is in compliance with the Australian Privacy Principles.
Declaration: I declare that I am over 18 years of age and legally competent to provide consent. I have read and fully understand the content and implications of this consent form. I have been informed that my identity will be protected, and my personal information will remain confidential. I am aware that I can withdraw my consent at any time by emailing info@ecplasticsurgery.com.au to request this, but understand that once my photos have been published, they may remain in circulation. I understand that any image of myself that is used in advertising, particularly on social media platforms, may be used by or commented on by a third party without East Coast Plastic Surgery’s or my knowledge. By signing below, I acknowledge and agree to the above statements and give my consent for the use of my photos as described.
I understand that I am free to withdraw my consent for the use of my images in advertising
at any time by emailing info@ecplasticsurgery.com.au to request this
